Medication Queue Blues

A little-known terror of the psychiatric inpatient system is the medication queue.

Imagine a group of mentally unwell people arriving at an inadequate row of plastic chairs in no particular order to wait for their personal medications to be dispensed through one of three glass windows, as the patients step up to a window, in order of arrival. Can anyone else see a problem with this?

It’s actually quite amazing that the ‘system’, such as it is, works so well. In all my hospitalizations, I’ve only ever seen or heard two blow-ups at medication time related to the queue system.

I’d better define some terms first. I’m talking about adult wards in private psychiatric clinics in Australia. All admissions are voluntary, and patients with more extreme problems are either in an intensive care unit or at a different type of hospital which can cater to their needs.

Some people take the medications queue in their stride, but I once brought it up in group therapy, and there was a general agreement that it’s a fairly stressful situation (all bar one extroverted and highly confident patient who couldn’t see what we were going on about). Because people arrive in dribs and drabs, there’s no order to the queue – so somehow you must remember who was there before you. I do it by counting heads. The problem with my method is that it doesn’t identify who’s still waiting, so if, say, the person immediately ahead of you in the queue forgets their place, there’s this awkward holdup while everyone says: “Were you next?” “Not me, I think it was you.” “Who, me?” [Yes, you. Just go to the window and get your fucking meds so the rest of us can move along.]

During the group therapy session in which I raised the topic, one brave soul suggested numbering the seats from left to right, and having people sit down in order and move along. A few problems were identified:

a) people are always being admitted to and discharged from the ward, so the new-though-sensible rules would need to be continually explained

b) some people bring knitting or other craft projects to keep them occupied while they wait, and won’t want to move seats

c) for some reason, no matter which hospital it is, there never seem to be sufficient seats

d)Β come on, we’re talking psych patients here! Are they really going to follow the rules?

Look, perhaps it’s just my anxiety talking, but it seems a minor miracle that the medication queue works at all. As a psychiatrist said to me once, with all these unwell people living in close quarters, it’s amazing we don’t have more disruptions.

Do you have a psych hospital bugbear? A story of systems which somehow hang together?

29 Comments

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29 responses to “Medication Queue Blues

  1. Huh. It’s interesting to see how the medical field functions in other countries….

    USA here, and although I have never been nor visited a ward I’ve been and visited pretty much everything but. Either whenever my father committed himself, or myself, it would be to a hospital that had a psychiatric floor or section or some equivalent. I haven’t witnessed this queue system… all systems I’ve seen here have nurses individually bringing medications or something more organized.

    It seems…. very…. Ugh, uncomfortable. I would hate it.

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    • Thank you!!! for affirming my discomfort πŸ™‚ It’s just so haphazard. Mind you, the three private psychiatric clinics I’ve spent time in are all owned/operated by the same company – might have something to do with it.

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  2. Ugh, med lines, yeah. When I’ve been inpatient, I’ve had those same conversations: “Who’s last?” “I think she is.” “No, he was after me.” “No, I was here first.”
    The worst is when there’s a set med hour and you can’t get meds outside of that time, but the line moves insanely slow.
    No, actually the worst was the time the computer system for the whole hospital crashed. Everything was done by computer–the meds were even in little drawers that the computer popped out. No one could get their meds, and a lot of things cause withdrawals or a return of symptoms if your dose is even a little late. I didn’t get my 8:00 a.m. meds until 3:00. Not good.

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    • You’re kidding!!! No, this was very low-tech: you’d saunter up to the counter when it was your turn, give your room number, and the nurse would fetch your cardboard file from the open filing cabinet behind her, then go to the meds cupboard and get your personal ‘bin’ out. We’re talking a medium sized ward – 50-odd patients at most – and usually three nurses operating out of three windows. Only the really anal retentive ones would insist on going through the whole rigmarole of getting you to state your full name and date of birth, because they generally knew us by name anyway, and there was always a photo on the front of the file. It was annoying when they asked you for your whole name: I always felt it was an invasion of privacy, because everyone could hear, and elsewhere in the hospital we were only ever referred to by first name.

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  3. Oh my gosh, yes. I can so relate to this. In private psychiatric hospitals I always tried to get to the medication room first because I am impatient. I hate waiting in those lines but at least everyone is pretty nice (again, in private psych hospitals). In public hospitals they bring the medication to you. Which again is annoying because if you take your meds at a certain time and they’re busy trying to get someone else to take meds, you have to wait. The last time I was in a public hospital they always commented on how compliant I was with taking my medication. I just wanted to get the hell out of there!
    Is it just my experience or does it always seem like an inconvenience if you want your medication at an earlier time? I’ve had issues with staff not giving me sleeping pills until 9 or 10 at night because they “act quickly” and they didn’t want me wandering around like a zombie. I told them they would actually help me get to sleep earlier if I took them at 8pm but I was never allowed to. Getting to sleep earlier is important because as I am sure you know, they like to wake you up nice and early!

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    • Yes, they are sticklers for the rules – well, 99.9% of the time. Legally, they’re not supposed to dispense prescribed medications at times other than when your doctor has written on the meds chart, apart from PRN medications (the ones you can request at any time – provided you can find a nurse with keys! – until you reach your maximum for the day). So their reluctance to issue you sleepers early may have been because your doctor wrote down a later dispensing time. However, they should have explained this to you, so you could have had your doctor change the dispense time.
      I have a medications bloke with very messy writing and one very rule-bound graduate nurse was going to refuse to give me a medication because she couldn’t read his writing, DESPITE the fact that three nurses had dispensed it previously. Thankfully a more experienced nurse leaned over and signed the box, saying “I can read his writing, I’ll sign for it”. Grrr.
      My medications bloke also once was very unavailable when I ran out of boxes in my PRN row, which was a pain in the arse, because I was heading out to see my other psychiatrist (for therapy – yes, I have two who split my care between them) and I was so unwell I was afraid to leave without having had an alprazolam. It would be lovely to say that a grizzled old nurse took mercy on me, took me into the meds room and slipped me a tablet – but of course I can’t say that, because his actions would have been technically illegal and all sorts of nastiness might ensue. πŸ˜‰

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      • Ah PRN. “Are you sure you want it?” “Do you really need it?” “Why don’t you do something relaxing and see if you feel better?” “You’ll have to wait, I can’t dispense that.” And of course, the key situation, ugh! Once they ran out of one of my regular meds and had to go take it from another patient’s box on another ward. There is a lot of med swapping that goes on, I think. It’s annoying! I was got told off for asking for my usual medication about two minutes before medication time. They can be real sticklers for the rules!
        Why do psychiatrists always have hard to read writing? Sometimes they chart things up incorrectly too and you just have to take what they have written even if it’s wrong.

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      • Yes, the good old PRN dance.
        Ahem … during a particularly bad medication change last year, I must admit I lost it and shouted out some rude words when the announcement went over the system: “1pm medications are currently being dispensed from the medications room.” “No they’re fucking not!” I screeched. The rapid med changes they put you through these days are not fun. For anyone!

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  4. eddieredvine

    I’ve never been an inpatient but even the thought of this system caused my anxiety. Basically my head said ‘nope, nope, nope’ I doubt I could handle that situation.

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  5. Technology can solve the problem but it costs more money than most would be willing to devote to such a task. The low-tech method is to issue a token to each patient as they arrive and match the medication in the order of arrival… yeah, I know, tokens would get swapped around. Two digital cameras (cheap) and a pc or two would solve this with software.

    Meds dispensed in order of arrival with near zero possibility of mix up through use of digital imaging and facial recognition… any peopld could sit anywhere… no explanations needed.

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  6. A sign in board would also fix this. It’s not high tech so even computer/camera illiterate nurses could use it.
    You go up to the board before you sit down, they swap one board for another that can be written on when they start calling names. (probably need about three to make sure there’s always one there.)
    Patients would have to PRINT not write their name, and that instruction would have to be clearly stated in large letters at the top of the sign in sheet (and if they don’t call you, it’s because they couldn’t read your name and then they can call out “anyone else” at the end it would only be about as bad as the current system, so this could cut in at least 2/3rd of the chaos now.)
    First name and initial would probably be enough to differentiate between 50 people.

    Simple. Then people don’t have a swap chairs or freak out about holding on to tokens (which you could do, like “red, green, blue” wooden spheres with the name of the colour on the sphere to be called, or the take a number thing, but I find that way more dehumanizing than names or colour tokens — though the latter is a little infantalizing. Calling names is better.)
    They could have the meds for the person ready before hand if they had a distinct name, cutting down on at least some time. (Just double check the picture and away you go)

    Okay, now tell me how this is gonna screw up. XD
    (If you think it’d work I guess suggest it to someone who works there as a way to improve. πŸ˜‰

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    • You’re right, I think that system would work πŸ™‚ thing is, hospital administrators seem to have the inertia of small dwarf stars – ain’t no budging them!
      But I don’t see any fundamental flaws in your concept.

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  7. When I was an in-patient, it was a kind of ad hoc queue. The biggest problem for the nurses is that they are meant to observe you taking the drugs (this happened in my experience but not sure if everywhere else). This was the general cause of chaos in my experience πŸ™‚ I tended to stay away until they came to hunt me down for them – my little attempt at rebellion and free will.
    My biggest bug bear was nurses interrupting you every 15mins to ask if you are OK. I wouldn’t mind but half the time I clearly wasn’t OK, but all they had to do was document that they had checked on me. I am ashamed to say that in my second form of rebellion and free will I used to hide from them!! Please forgive me.
    The worst thing of all though, is that I used to be a nurse so these should be my peers..Shame on me!!! (although I would probably do it all again πŸ˜‰

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    • Ha ha! Yes, we all swallowed our tablets at the counter. I would get pissed off if some PITA nurse would ask me to do the whole “open your mouth, raise your tongue” routine because I am very compliant when it comes to medications.
      You poor thing, it must have been awful, being a nurse and being in a psych ward environment! I remember being in once when a nurse was on the same ward. She really did not cope well with being a patient and complained about everything. All the time. To anyone. She was also an awful gossip and was asked to leave the hospital after spreading some untruths about a fellow patient, a big no-no, particularly on a psych ward. Obviously most of these things were unrelated to being a nurse, but I’m sure it didn’t help, knowing how things were “supposed” to work and seeing them not working in that manner.
      Good old tick-the-box care! Once I was so desperate I called LifeLine from the hospital because I couldn’t find anyone to talk to me. I suppose you’ve got to laugh …

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      • Calling Lifeline from the Psych ward is the absolute best thing I have heard. What on earth did they say? You’re spot on with the tick the box care. It frustrated me so much as when I was nursing I was very much there for the patients over and above anything else. If I said to them I would do something, I would do it.
        I’ve just realised I said ‘frustrated’ above – excellent, going back to other post we both know this means angry.
        The hardest thing being the patient, was having control taken away. I used to hate it when I walked past the nurses station and they would know my name, for me that was the absolute worst. Strange.
        We’ll have to get our heads together and write a book about our experiences πŸ˜‰

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      • Yes!!! Sounds great. Where in the world do you live? I’m in Australia. (Or have we already had that conversation? If so, I am so sorry …)
        Yeah, the LifeLine operator listened for a while, then pretty much just told me to go find a nurse to talk to. I mean, what else could she do? In theory, I was already receiving the best care the system had to offer. I must admit I did get noticed when I mentioned that I’d called LifeLine πŸ™‚
        I know a doctor who works in an ER department. I told her this story and she answered with one about people who call ambulances from the ER waiting room. She gets pissed off with them, seeing their behaviour as “manipulative”, but she had great sympathy with my story. That was kind of her.

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      • Whereabouts in Australia are you? My best friend lives in Perth so I have spent a lot of time there, with the odd visit to the east coast. I’m in the UK, just north of London. Freezing cold at the moment and dreaming of sun πŸ™‚
        I’m with your ER doctor about people calling ambulances from the waiting room. There is a real difference having been triaged and then having to wait a bit for treatment (I’m in the UK remember, we are great at waiting), and being an in patient, where you are being deprived your primary source of treatment and care. I had so many experiences as a nurse where the one that shouted loudest got my attention rather than the one that was the sickest. I hated it.

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      • I’m in Victoria, in the south-east of Australia.
        At one stage I was a teacher, and it was the same deal: the kids (or parents!) who – sometimes literally! – shouted loudest got the most attention. I don’t teach any more. I can’t ever imagine going back to the classroom: it’s too tough a gig – either you’re at a terrible school, where life in the classroom is hell, or you’re at a “good” school, where in theory life in the classroom is better, but you’re expected to put in many hours above and beyond those stated in the Award.
        I don’t know that I could do nursing, either. Psych nursing, perhaps – fewer bodily fluids! – but regular nursing? Maybe not.

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      • Spooky, I was a childrens nurse. I’m with you, I couldn’t go back to it. How would you respond to the following statement: The worst thing about working with children is dealing with the parents.
        I haven’t made it to Victoria. It has to be one of the few areas I don’t know much about.
        Hope no parents are reading this ;-(

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      • Ah, there will be parent reading, and the wise ones will be nodding and agreeing. This is one reason I blog using a pseudonym – complete freedom of expression! I never used to get the whole anonymity thing, couldn’t understand by Nikki Gemmel published “The Bride Stripped Bare” anonymously, but now I do – I imagine she, like me, would have found the freedom to write and not having to censor your words liberating.
        (I do also write under my own name elsewhere, but not about my own mental health.)

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